Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | R1763 | TX |
NPI | 1053686121 |
---|---|
Provider Name | Lucile Parker Gregg |
First Address | Dallas, TX 75390-8516 |
Second Address | Dallas, TX 75390-8516 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2012 |
Last Update Date | 18/08/2020 |